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在心脏肿瘤护理的迷宫中驾驭P2Y12抑制:癌症患者的坎格雷洛桥接治疗

Navigating P2Y12 inhibition in the labyrinth of cardio-oncology care: cangrelor bridging in patients with cancer.

作者信息

Ali Abdelrahman, Jewani Poonam, Bourdillon Max, Koutroumpakis Efstratios, Khalaf Shaden, Charitakis Konstantinos, Thompson Kara, Marmagkiolis Konstantinos, Deswal Anita, Iliescu Cezar

机构信息

Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States.

Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas, Houston, TX, United States.

出版信息

Front Cardiovasc Med. 2024 Feb 29;11:1337957. doi: 10.3389/fcvm.2024.1337957. eCollection 2024.

DOI:10.3389/fcvm.2024.1337957
PMID:38486704
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10937743/
Abstract

Cangrelor, a potent intravenous P2Y12 platelet inhibitor, has demonstrated effectiveness in reducing ischemic events without a corresponding increase in severe bleeding during percutaneous coronary intervention, as evidenced by the CHAMPION-PHOENIX trial. Its off-label role as a bridging antiplatelet agent for patients facing high thrombotic risks who must temporarily stop oral P2Y12 inhibitor therapy further underscores its clinical utility. This is the first case series to shed light on the application of cangrelor in cancer patients needing to pause dual antiplatelet therapy for a range of medical interventions, marking it as a pioneering effort in this domain. The inclusion of patients with a variety of cancer types and cardiovascular conditions in this series underlines the adaptability and critical role of cangrelor in managing the dual challenges of bleeding risk and the need for uninterrupted antiplatelet protection. By offering a bridge for high-risk cancer patients who have recently undergone percutaneous coronary intervention and need to halt oral P2Y12 inhibitors temporarily, cangrelor presents a practical solution. Early findings indicate it can be discontinued safely 2-4 h before medical procedures, allowing for the effective reintroduction of oral P2Y12 inhibitors without adverse effects. This evidence calls for expanded research to validate and extend these preliminary observations, emphasizing the importance of further investigation into cangrelor's applications in complex patient care scenarios.

摘要

坎格雷洛是一种强效静脉注射P2Y12血小板抑制剂,CHAMPION - PHOENIX试验证明,在经皮冠状动脉介入治疗期间,它能有效减少缺血事件,且不会相应增加严重出血的发生率。对于面临高血栓形成风险且必须暂时停用口服P2Y12抑制剂治疗的患者,坎格雷洛作为桥接抗血小板药物的非标签应用进一步凸显了其临床实用性。这是首个揭示坎格雷洛在因一系列医疗干预措施而需要暂停双联抗血小板治疗的癌症患者中的应用情况的病例系列,标志着在这一领域的开创性努力。该系列纳入了患有各种癌症类型和心血管疾病的患者,突显了坎格雷洛在应对出血风险和持续抗血小板保护需求这双重挑战方面的适应性和关键作用。通过为近期接受经皮冠状动脉介入治疗且需要暂时停用口服P2Y12抑制剂的高危癌症患者提供桥梁,坎格雷洛提供了一个切实可行的解决方案。早期研究结果表明,在医疗程序前2 - 4小时可安全停用坎格雷洛,从而能够有效重新引入口服P2Y12抑制剂且无不良反应。这一证据呼吁开展更多研究以验证和扩展这些初步观察结果,强调了进一步研究坎格雷洛在复杂患者护理场景中的应用的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0323/10937743/df031c7f423a/fcvm-11-1337957-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0323/10937743/df031c7f423a/fcvm-11-1337957-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0323/10937743/df031c7f423a/fcvm-11-1337957-g001.jpg

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本文引用的文献

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Use of Cangrelor as a Bridge to Left Ventricular Assist Device Implantation in a Patient with a Recent Drug-Eluting Stent Who Developed Acute Tirofiban-Related Thrombocytopenia.在近期接受药物洗脱支架治疗且发生急性替罗非班相关性血小板减少症的患者中,使用坎格瑞洛作为左心室辅助装置植入的桥接治疗。
Pharmacotherapy. 2019 Apr;39(4):521-525. doi: 10.1002/phar.2219. Epub 2019 Mar 4.
2
A Case Report of Cangrelor Bridge Therapy for a Diagnostic Bronchoscopy With Biopsy.Cangrelor 桥接治疗用于诊断性支气管镜检查和活检的病例报告。
J Pharm Pract. 2020 Apr;33(2):231-235. doi: 10.1177/0897190018795343. Epub 2018 Aug 23.
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Incidence, Predictors, and Outcomes of Acquired Thrombocytopenia After Percutaneous Coronary Intervention: A Pooled, Patient-Level Analysis of the CHAMPION Trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition).
经皮冠状动脉介入治疗后获得性血小板减少症的发生率、预测因素和结局:CHAMPION 试验(替卡格雷与标准治疗以实现血小板抑制最佳管理)的汇总、患者水平分析。
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SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista).SCAI专家共识声明:心脏导管实验室中心脏肿瘤患者的评估、管理及特殊考量(印度心脏病学会和拉丁美洲介入心脏病学会认可)
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Effect of platelet inhibition with cangrelor during PCI on ischemic events.PCI 中用坎格瑞洛进行血小板抑制对缺血事件的影响。
N Engl J Med. 2013 Apr 4;368(14):1303-13. doi: 10.1056/NEJMoa1300815. Epub 2013 Mar 10.
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Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial.在心脏手术患者中用坎格雷洛桥接抗血小板治疗:一项随机对照试验。
JAMA. 2012 Jan 18;307(3):265-74. doi: 10.1001/jama.2011.2002.
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Intravenous platelet blockade with cangrelor during PCI.经皮冠状动脉介入治疗(PCI)时,使用坎格雷洛进行静脉内血小板阻断。
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Platelet inhibition with cangrelor in patients undergoing PCI.在接受 PCI 治疗的患者中使用坎格雷洛进行血小板抑制。
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